Neonatal sepsis is one of the significant reasons for morbidity and mortality among the neonates in the developing countries. To determine the bacterial isolates and their antibiotic susceptibility pattern. Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1 year. Identification of all pathogenic isolates was done by conventional methods followed by antibiotic sensitivity testing by Kirby bauer disk diffusion method. A total of 225 suspected for neonatal septicemia were included in this study. Among this 78(34.7%) found to be positive, males were 48(61.54%) and females 30(38.46%). Early onset 69(88.46%) followed by late onset 9(11.54%). Among the total isolates gram positive cocci 48(61.53%) followed by Gram negative bacilli were 24(30.67%) and candida 6(7.69%). Among Gram positive cocci isolates vancomycin, Linezolid and teicoplanin was 100% susceptible. The total of gram negative bacilli isolates Imipenem and Meropenem of 100% susceptible.
Int.J.Curr.Microbiol.App.Sci (2019) 8(8): 2807-2812 International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume Number 08 (2019) Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2019.808.323 Neonatal Septicemia: Microbiological Profile and Antibiotic Sensitivity Patterns Astha Gupta1, Yogendra Singh1* and Ramesh Yadav2 Demonstrator Department of Microbiology Government College, Orai Jalaun, India Department of Microbiology Government College, Orai, Jalaun, India *Corresponding author ABSTRACT Keywords Bacteria, neonatal septicemia, antibiotic, onset septicemia, latesepticemia Article Info Accepted: 22 July 2019 Available Online: 10 August 2019 Neonatal sepsis is one of the significant reasons for morbidity and mortality among the neonates in the developing countries To determine the bacterial isolates and their antibiotic susceptibility pattern Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1‑ year Identification of all pathogenic isolates was done by conventional methods followed by antibiotic sensitivity testing by Kirby bauer disk diffusion method A total of 225 suspected for neonatal septicemia were included in this study Among this 78(34.7%) found to be positive, males were 48(61.54%) and females 30(38.46%) Early onset 69(88.46%) followed by late onset 9(11.54%) Among the total isolates gram positive cocci 48(61.53%) followed by Gram negative bacilli were 24(30.67%) and candida 6(7.69%) Among Gram positive cocci isolates vancomycin, Linezolid and teicoplanin was 100% susceptible The total of gram negative bacilli isolates Imipenem and Meropenem of 100% susceptible Introduction Neonatal sepsis is defined as an invasive bacterial infection which occurs in the first weeks of life.(1)It is of two types, sepsis occurring in the first 72 hours of life is defined as early-onset sepsis (EOS) and that occurring beyond 72 hours as late-onset sepsis (LOS).(2)The information about both the common pathogens causing septicemia in neonates and their antimicrobial susceptibility makes easy to select appropriate antimicrobial treatment Neonates are more prone to infections due to their weak immunity Moreover, other risk factors, both in the neonates and in the mothers, are responsible for causing susceptibility to infection.(3)The microorganisms most common associated with EOS include Group B Streptococcus (GBS), Escherichia coli, coagulase negative Staphylococcus species (CONS), Haemophilus influenza and Listeria monocytogenes, and LOS is caused by CONS, S aureus, E coli, Klebsiella spp., Pseudomonas spp., 2807 Int.J.Curr.Microbiol.App.Sci (2019) 8(8): 2807-2812 Enterobacter spp., Candida spp., GBS, Serratia species, Acinetobacter spp and anaerobes The recent trends show an increase in infections due to CoNS.(4) Reported rates of neonatal septicemia as per admission in the literature range from 6% to 50% with 3-to 20fold higher rates in developing countries as compared to developed countries.(5) The overall mortalityrate varies between 20% and 80% depending on the risk factors.(6)In addition; there exists wide variation in the bacteriological profile and antibiogram of microorganisms in different NICUs which changes consistently with time The information regarding this may helps for selection of antibiotic and prevent from irrational use Exclusion criteria Infants more than month were excluded from the study Ethical consideration Ethical clearance was taken from Institutional ethical committee Specimen collection ml of fresh blood were collected under aseptic precautions using a sterile syringe from neonates from clinically suspected neonates in BHI Broth (brain heart infusion broth) (Hi Media, Mumbai, India) Ratio of blood to broth 1:10 Hence, this study was conducted to know causative agents of neonatal and their antibiotic susceptibility patterns Specimen transport Materials and Methods Specimens were transported to the laboratory as soon as possible after collection and incubated as soon as possible at 37°c Study settings Specimen processing This study was conducted in Department of Microbiology, Rama Medical College, Hospital and Research Centre Kanpur, UP This study was conducted from 2017 to 2018 All blood cultures samples were processed in laboratory using standard procedure by conventional method and incubated for 48 hours and then sub-cultured onto blood agar and Mac-Conkey agar to look for growth From the obtained growth isolated colonies were identified by standard bacteriological protocol.(7)and antibiotic sensitivity was done by Kirby Bauer’s method according to CLSI guidelines(8)and no growth plates were incubated for further 2nd, 4th and 6th day, samples were reported as no growth after days of aerobic incubation.(7) Inclusion criteria Results and Discussion Newborn babies who were clinically suspected for sepsis and admitted to NICU were included in this study Neonatal sepsis most commonly occurs in prematurely born babies who undergo aggressive therapeutic measures in order to Study subjects A total of 225 non –repetitive blood samples were collected from the clinically suspected cases of NICU patient A detailed clinical history of the patients was collected Study period 2808 Int.J.Curr.Microbiol.App.Sci (2019) 8(8): 2807-2812 maintain vital functions Another group of infants with a high risk are those born from pregnancies complicated with mother-related infections like premature rupture of membrane, low birth weight, congenital anomalies, maternal febrile conditions, mother urinary tract infection, premature rupture of membranes, especially more than 18hrs, before delivery and multiple pregnancies (9) septicaemia in other studies may be due to low socioeconomic status of their parents, poor hygiene practices, bottle feeding and high incidence of delivery at home (13) In this study neonatal sepsis was more frequently diagnosed in babies born below the 30th week of gestation and lower birth weight Similar data were reported in the study of Stoll et al., (14) In this study table number showed that 69 (88.4%) were early onset and (11.5%) were late onset of neonatal septicemia In other studies of Jyothi et al., 2013 early onset was (74.8%) and late onset was (25.2%) and S Skrajcinovic et al., early onset (48%) and late onset was (52%) which showed more difference between early onset neonatal septicemia and late onset The variation in early onset and late onset may be due to the study setting, stay of hospital duration, prior use of antibiotics In this study 225 blood culture samples were taken among them 78 were culture positive, a high prevalence rate of 78 (34.6%) was seen, which is approximately similar to Arora et al., 33.7% (10) and lower than the other studies done in India, by Khanal et al., 33.9% (11) and Sharma et al., 44% (12).The reason for this could be the less number of sample included in the study, or anaerobic bacteraemia or a false history from patients with use of antibiotics High prevalence of Table.1 Distribution of suspected neonatal septicemia Positive Negative Total 78 147 225 34.7% 65.3% 100.0 Table.2 Sexwise distribution suspected case Male Female Total 87 138 225 38.66% 61.33% 100% Table.3 Sexwise distribution of positive case Male Female Total 30 48 78 38.46% 61.54% 100.00% Table.4 Distribution of Early onset and late onset Early onset Late onset Total 69 78 2809 88.46% 11.54 100.00% Int.J.Curr.Microbiol.App.Sci (2019) 8(8): 2807-2812 Table.5 Distribution of isolate Isolates CoNS Klebsiella pneumoniae Pseudomonas aeruginosa MSSA MRSA Acinetobacter species E.coli Candida krusei Candida tropicalis Total Positive 39 12 6 3 3 78 Percentage 50% 15.4% 7.7% 7.7% 3.8% 3.8% 3.8% 3.8% 3.8% 100% Table.6 Antibiotic patterns of Gram negative bacilli Antibiotics AMP AK GEN NET CAZ CTX CIP PIT IPM MRP AT AMC Klebsiella pneumoniae (n=12) 41.67% 58.33% 58.33% 66.67% 66.67% 66.67% 50.00% 66.67% 12 100.00% 12 100.00% 66.67% 0.00% Pseudomonas aeruginosa (n=6) 50.0% 66.7% 66.7% 66.7% 50.0% 50.0% 33.3% 100.0% 100.0% 100.0% 100.0% 50.0% Acinetobacter spp (n=3) 66.67% 66.67% 66.67% 66.67% 66.67% 66.67% 33.33% 100.00% 100.00% 100.00% 100.00% 100.00% 3 3 3 3 2 E.coli (n=3) 33.33% 100.00% 100.00% 100.00% 100.00% 100.00% 66.67% 100.00% 100.00% 100.00% 66.67% 66.67% 11 16 16 17 16 16 11 20 24 24 19 20 Total (n=24) 45.83% 66.67% 66.67% 70.83% 66.67% 66.67% 45.83% 83.33% 100.00% 100.00% 79.17% 83.33% Ampicillin (AMP), amikacine (AK), Gentamicin (GEN), Cefotaxime (CTX), Ceftazidime (CAZ), Ciprofloxacin (CIP), Piperacillin-tazobactam (PIT), Imipenem (IMP), Meropenem (MRP), Aztreonam(AT), Amoxyclave (AMC) Table.7 Antibiotic patterns of Gram positive cocci Antibiotics P E CD AK CX VA LZ CoNS (n=39) 30 76.92% 35 89.74% 37 94.87% 30 76.92% 39 100% 39 100% 39 100% MSSA (n=6) 42.86% 42.86% 57.14% 42.86% 85.71% 85.71% 85.71% MRSA (n=3) 0.0% 33.3% 66.7% 66.7% 0.0% 100% 100% Total (n=48) 33 68.8% 39 81.3% 43 89.6% 35 72.9% 45 93.8% 48 100% 48 100% Penicillin (P), Erythromycin (E), Clindamycin (CD), Amikacin (AK), Cefoxitin (CX), Vancomycin (VA), Linezolid (LZ) 2810 Int.J.Curr.Microbiol.App.Sci (2019) 8(8): 2807-2812 In this study among gram positive pathogen CONS 39(50%) and methicillin sensitive staphylococcus aureus 6(8%), methicillin resistant staphylococcus aureus 3(4%) were most common isolates similar to Vanitha et al., 8.2% (15) Among Gram positive cocci isolates vancomycin, linezolid and teicoplanin was 100% susceptible In other studies the Candidemia was much higher (20.29%) (16) While in present study 4% of positive blood culture From the other studies it was observed that antibiotic resistance among the Gram-positive isolates was highest to penicillin (87%) followed by amoxyclav (66%).Similar reports of high resistance to Ampicillin (71%) were reported by Bhat et al., (17) All the Gram-positive isolates were sensitive to vancomycin similar to a study by Hoogen et al., (28) In the present study, 4% S aureus isolates were found to be methicillin-resistant, compared to 11.1%reported by Kaistha et al., (19) The total of gram negative bacilli isolates Imipenem and Meropenem of 100% susceptible which is similar to the resistance pattern reported by Bhat et al., (17) In this study, the common isolate of blood cultures were coagulase-negative Staphylococcus species This could be a skin normal flora due to contaminant Education, and awareness of health care worker, use of sterile sets for blood cultures sampling and checklists, permanent organization of false positive blood cultures, likewise as regular and routine monthly reports are key factors for success in reducing contamination rates Among Gram positive cocci isolates vancomycin, Linezolid and teicoplanin was 100% susceptible References The total of gram negative bacilli isolates Imipenem and Meropenem of 100% susceptible 2811 D E Premalatha, MallikarjunKoppad, L H Halesh, K.C Siddesh, N Prakash The 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neonatal candidemia in a tertiary care institution in Hyderabad, South India Int J Res Med Sci 2014; 2: 1016-19 Bhat Y R, Lewis LE, Ke V Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: An audit from a center in India Ital J Pediatr 2011; 11: 37:32 Van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents Neonatology 2010;97:22-8 Kaistha N, Mehta M, Singla N, Garg R, Chander J Neonatal septicemia isolates and resistance patterns in a tertiary care hospital of North India J Infect Dev Ctries 2009; 4:55-7 How to cite this article: Astha Gupta, Yogendra Singh and Ramesh Yadav 2019 Neonatal Septicemia: Microbiological Profile and Antibiotic Sensitivity Patterns Int.J.Curr.Microbiol.App.Sci 8(08): 2807-2812 doi: https://doi.org/10.20546/ijcmas.2019.808.323 2812 ... to cite this article: Astha Gupta, Yogendra Singh and Ramesh Yadav 2019 Neonatal Septicemia: Microbiological Profile and Antibiotic Sensitivity Patterns Int.J.Curr.Microbiol.App.Sci 8(08): 2807-2812... epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents Neonatology 2010;97:22-8 Kaistha N, Mehta M, Singla N, Garg R, Chander J Neonatal septicemia isolates and resistance patterns. .. agents of neonatal and their antibiotic susceptibility patterns Specimen transport Materials and Methods Specimens were transported to the laboratory as soon as possible after collection and incubated